What is a circumcision?

Circumcision is the surgical removal of the foreskin of the penis.

Why do a circumcision?

In adults the operation is carried out for medical reasons. These include prevention of recurrent infections of the foreskin (balanitis), inability to withdraw the foreskin over the head of the penis (phimosis), inability to pull a retracted foreskin back over the head of the penis (paraphimosis) and sometimes to make a diagnosis of an abnormality of the foreskin.

What does the surgery involve?

The procedure can be carried out either under a general anaesthetic (when you are asleep) or local anaesthetic (where the area is numbed and you remain awake). The foreskin covering the head of the penis is gently cut away and the remaining skin is then stitched back using dissolvable stitches. The procedure usually takes about 20-30 minutes.

What are the benefits?

The main benefits are the relief of pain, discomfort or inflammation, or to allow a precise diagnosis of a problem with the foreskin.

What are the risks?

Circumcision is a commonly performed procedure. However, as with any surgery, complications do occasionally occur and may include:

Post-operative bleeding, requiring further corrective treatment and sometimes the need to return to theatre.

Displeasing cosmetic results

A change in appearance of the glans (head of penis) because of the underlying disease process and the difficulty of separating the foreskin, which is fused to the head of the penis.

An infection that may need to be treated with antibiotics

On rare occasions, a change in sensation of the penis, either during sexual intercourse or, an awareness of increased sensitivity at the tip (‘head’ or ‘glans’ ) of the penis, when not having sexual intercourse. This increased awareness may actually be felt as discomfort or pain in some cases.

On rare occasions, narrowing of the urinary opening (meatal stenosis) may occur. This may impede urination and require corrective treatment.

Are there any alternatives?

Conservative measures may be appropriate, depending on the original reason for the surgery. These treatments include anti-inflammatory, antifungal or antibiotic ointments, although these may not be effective in the long term.

What would happen if my symptoms were left untreated?

The original problem for which a circumcision was suggested may continue or get worse. If the foreskin should become stick in a retracted position (where the foreskin cannot be brought back to its usual position) this is known as paraphimosis and may require urgent treatment.

How long will I be in hospital?

Circumcision is a day case procedure and you will normally be able to go home as soon as you feel comfortable. If you have a general anaesthetic, you will need to stay in the unit for a minimum of two hours after your surgery.

What happens before the operation?

Prior to admission, you will need a pre-operative assessment. This may be performed using a health questionnaire, over the telephone, or at a pre-assessment clinic. Before the date of your admission, please read very closely the instructions given to you. If you are undergoing a general anaesthetic, you must stop eating food and milk products at least six hours prior.

What happens after the operation?

Your blood pressure, pulse and wound will be checked. You will be offered light refreshments as soon as you feel ready. The nurses will let you know when you can get up. Some pain is to be expected around the wound site. The nurse will check how you are feeling and give you painkillers, if necessary. A small amount of bleeding from the wound may also occur. Nurses will monitor the wound site and apply further dressings, if necessary. You can usually go home when you are comfortable and the effects of the anaesthetic have worn off. NOTE: a general anesthetic can temporarily affect your co-ordination and reasoning skills, so you will need a responsible adult to take you home and stay with you for the first 24 hours. During this time, it is also important you do not operate machinery, drive or make important decisions. Before your discharge, the nurse will advise you about your post-operative care and will give you a supply of painkillers. Your GP will be notified of your treatment. After discharge, you are advised to see your GP for any follow up requirements. If the surgeon does wish to see you again, you will be notified of this prior to discharge and appointment card will be posted to you.

What activities will I be able to do after my surgery?

After your surgery you can return to normal physical activities when you feel comfortable, although it is wise to avoid heavy or strenuous activity for the first couple of weeks. It is important to avoid sexual activity for at least four weeks as this may cause pain and bleeding.

How much pain can I expect?

It is normal to experience some pain and soreness around the wound site, particularly over the first few days. It is therefore important for you to take painkillers regularly over the first two to three days (but remember that you should not exceed the stated maximum daily dose). If the level of pain is still not acceptable to you, your local pharmacist should be able to offer you advice. If pain should become increasingly worse, you should consult your GP. You may notice some discomfort for several weeks after the operation.

How do I care for my wound?

You can remove the wound dressings the day after your surgery. You should then shower or bathe daily. Over the first week or so, you may notice a sticky discharge around the wound that should be gently washed away. Soap and water is entirely adequate and you may wash as often as you wish. Between washes it is important to keep the area clean and dry until healed. Most stitches are self-dissolving and will dissolve after a few weeks. Marked swelling and bruising of the penis is common after surgery and should subside over a couple of weeks. If your wound should become increasingly painful, swollen or mucky you should see your GP. Rarely a bleed can occur from the wound several days after surgery. If this should occur, apply gentle pressure to the wound using a clean cloth. Any bleeding should subside after a few minutes. If bleeding continues or becomes very profuse, you should attend the nearest casualty department.

When can I return to work?

You can return to work as soon as you feel well enough-usually after a few days. If your work is heavy or strenuous, you may need about two weeks off work.

When should I seek help?

If you develop a fever above 38.5o C (101o F) or shivering and chills (rigors).

Increasing pain, redness, swelling or discharge of the wound site.

Bleeding that soaks through dressings and onto clothes or requires several changes of dressings in the first few days,